B-2017-0600CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10285 PARKWOOD DR APT 1 I CUPERTINO, CA (326 27 036)
NO: B-2017-0600
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP DATE ISSUED: 04/19/2017
OWNER'S PHONE: 650-961-8330 PHONE NO: (408) 988-8744
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-4: 10. 20, 36, 38 Lic. #256057
Contractor THERMAL MECHANICAL Date 01/31/2018
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
r. I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
_-I-have and will maintain Worker's Compensation Insurance, as provided for by
f Section 3700 of the Labor Code, for the performance of the work for which this
is issued.APPLICANT CERTIFICATION
IcFrtif(_,p"'t
y that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree to save indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per th Cupertino Municipal Code, Section 9.18.
Signature Date 4/1912017
QWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's' License Law for one of the
following two reasons:
r. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
r. I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
s. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
SignatureDate 4/19/2017
X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
BLDG #9/UNIT #11; ADD (N) A/C; REPLACE FURNACE, SAME
LOCATION; (N) WASHER AND DRYER HOOK UPS; (I) ELECTRICAL
SERVICE (70 AMP); (N) GAS LINE FOR STOVE; (I) RECEPTACLE
OUTLETS; (I) LIGHT; (I) BATHROOM EXHAUST FANS.
Sq. Ft Floor Area: Valuation: $20000.00
APN Number: Occupancy Type:
326 27 036
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
Date: 04/19/2017
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature ofApplicant:
Date: 4/19/2017
TO BE CLASS "A" OR
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material.. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Se s 25505, 25533, and 25534.
Owner or authorized agent:
Date: 4/1912017
CONSTRUCTION NDINA NCV -
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Profession
UTE R€Ill0
CONSTRUCTION T APPLICATION 9
/0�m
COM41f1U II TY DEVELOPMENT JEPARTMENT a 8UiLDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(493) 777-3223 a FAX (408) 777-3333 s
❑ NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION / TI ❑ REVISION /-DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10285 Parkwood DR, BLDG 9, Unit #11
APN# `
OWNERNAME Avery Glenbrook LLC
PHONE 650-961-8330
E-MAIL averY@pacbell.net
STREET ADDRESS 130 East Dana Street
CITY' STATE, ZIP Mt. View, CA 94041
FAX 650-961-0571
CONTACT NAME Rob Moyer
PHONE 408-593-8115
E-MAIL, rmoyer@thermaimech.com
STREET ADDRESS 425 Aldo ave.
CITY, STATE, ZIP
Santa Cara, CA 95054
FAX 408-988-0233
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT I CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAMEThermal Mechanical
—7
LICENSE NUMBER 256057
0-4,,LICENSE
C-4 10 20 36 38
2010
BUS. LIC# 299
cOMPANYNAME Thermal Mechanical
E-MAIL rmoyer@thermalmech.com
FAX 408-988-0233
STREET ADDRESS 425 Aldo ave.
crrY, STATE," Santa Clara, CA 95054
PHONE 408-988-8744
ARCAITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK add new AC, replace furnace in same location, (N) washer/dryer hook ups, (N) electrical panel (70 AMP),
(N) gas line for stove, (N) electrical outlets, (N) light, (N) bathroom exhaust fan
EXISTI NGUSE -
PROPOSED USE
CONSTR. TYPE
1 # STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMODELAREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECKlPORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
#DWELLINGUNITS:
ISA SECOND UNIT OYES
SECOND STORY 11 YES
ti
BEINGADDED? ONO
ADDITION? ONO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
EIVED B Y 4
TOTAL VALUATION:
I
PLANNING APPL # ❑ NO PLANNING
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf I ave read this
and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
application
ordinances and state laws relating to building Sri I authorize representatives of Cupertino to enter the above -identified pro erty for inspection purposes.
Signature of Applicant/Agent: Date: C
SUPPLEMENTAL ORMATION REQuL0b
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
_
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
E] ERESS
ElPLANNING PLAN REVIEW
Bldgs: Provide a completed Hazardous Materials Disclosure
f�STDARD
❑ PUBLIC WORKS
_Commercial
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
El MAJOR
El SANITARY SEWER DISTRICT
_
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1. doe revised 06121/11
P,
SMOKE I CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
30MMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
CUPERT(NO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildinnaminartinn nrn
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or .repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
ivlonoxide Alarms be installed in the fc:owung locations:
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of X X
`he bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X --
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery. operated.
Til existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access .by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below.
Specify Number of Alarms:
# Smoke
Permit No.'s —?,o f )- 00 I,
ED
l have read and agree to cOmPlY with ttilarmLgnd conditions of this statement
Owner (or Owner Agent's) Name:
.74/pfES,Signature...............................S......�.........................
..............
Date:
?1
`
onractorName: ...................................................................................................................
Te✓��t H Signature...... 7%1 Lic.# .,.....Date.
................................................
y �I
,7r7,ni,-o rrnri rn fn m, jinn noi»irs
Owner Naive
',.ddress /0
'NATER-CONSERVING PLUMBING FIXTURES
r)WNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
-108) 777-3228 • FAX (408) 777-3333 • buildingCc cuoertlno ora
CYennit No Z�9 � -0&00
0
l , :s your real property a registered historical site?
11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 2.
Does' your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
j)lumbing, installation of water -conserving plumbing fixtures is not technically feasible?
-3,Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply.
,'� The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
❑ No Go to Question 3.
Is water service permanently disconnected for your building?
7 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of forin.
,A No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of foinL
Yes My real property is built and available for use or occupancy on or before January 1, 1'194.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
cottom of form.
Please check ONE of the following:
J My property is a single family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-
compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
L My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
unprovements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations. or improvements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on the following nnap ----- -- 1>
Owner or Owner Agent's Signature:
c J Date:
471 , -4 1 ,
Upon completing and signing thus Certificate, please return it to the Building Division in order to finit
al your building perm
,24071015.doc revised 08/26/15